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General NPI Number Information
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NPI Number | 1295937654
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Entity Type | Individual
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Provider Name | ROY WILLIS MINER JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 11/24/2024
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Provider Practice Location Address
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Address Line | 400 TAYLOR RD
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City | MONTGOMERY
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State | AL
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Zip | 36117-3512
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Country | US
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Telephone | 334-747-8448
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3395
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City | EVANSVILLE
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State | IN
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Zip | 47732-3395
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01064362A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 42129
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License Number State | AL
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